Updated on: July 22, 2025

DocScrib Review of Systems (ROS) Template with Examples

Review of Systems Template for Clinicians (With Real-Life Examples)

A Review of Systems (ROS) is a vital component of patient evaluation. It serves as an organized checklist of symptoms covering major body systems, allowing clinicians to gather comprehensive information from the patient beyond the chief complaint. Conducting a thorough ROS helps uncover hidden conditions, supports accurate diagnosis, and enhances clinical documentation—especially when powered by intelligent tools like DocScrib.

Is the Review of Systems Outdated or Essential?

There’s ongoing debate in the clinical community about the relevance of the Review of Systems. Some clinicians view the ROS as a relic of the past, especially since the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) revised their Evaluation and Management (E/M) guidelines in January 2021. These newer regulations no longer demand a complete ROS for every patient encounter, giving providers more flexibility to tailor their documentation.

On one hand, those who consider the ROS outdated often see it as a checkbox exercise—an administrative hurdle that rarely contributes new insights when the chief complaint is already well understood. They point out that documentation requirements are lighter now, freeing up valuable time for clinicians to focus on direct patient care and individualized conversations.

On the other hand, many providers still regard the ROS as indispensable. They argue that it routinely uncovers overlooked symptoms or unexpected conditions—things that might never come up if the conversation centered solely on the presenting problem. In fact, studies have shown that a sizable portion of new problems are detected only through a systematic review of symptoms. For these clinicians, the ROS remains a cornerstone of comprehensive, patient-centered care. It not only enriches diagnostic accuracy but can reveal underlying patterns or connections that shape more effective treatment plans.

🏥 What Is the Review of Systems (ROS)?

The Review of Systems (ROS) is a systematic series of questions posed to the patient, aimed at identifying any symptoms they may be experiencing across various body systems. It is typically performed after taking the History of Present Illness (HPI) and serves as a bridge between the patient’s subjective concerns and the objective findings of the physical examination.

While the ROS focuses on patient-reported symptoms—often uncovering red flags that may or may not be related to the chief complaint—it is distinct from the physical exam. For example, a patient presenting with fatigue might, during the ROS, also mention night sweats and unintentional weight loss. These additional symptoms could prompt a clinician to explore further, guiding the subsequent steps in diagnosis.

Unlike ROS, the physical examination is based on clinician-observed findings. Here, techniques such as inspection, palpation, percussion, and auscultation are employed to gather objective data. For instance, if a patient notes chest pain during the ROS, the clinician might respond by conducting a focused exam—listening to heart and lung sounds to detect murmurs or abnormal breath sounds.

In summary, the ROS captures the patient’s subjective experience, helping to direct the clinician’s attention before the hands-on assessment begins.

The ROS enables:

• Detection of additional or unrelated symptoms
• Discovery of early signs of new conditions
• Documentation compliance with billing and regulatory requirements

The goal is to avoid missing potentially important clinical information while maintaining efficiency and patient engagement.

🔢 Types of ROS (Per CMS Guidelines)

The Centers for Medicare & Medicaid Services (CMS) classifies ROS into three levels based on the depth of review:

📋 Recent Changes in AMA & CMS E/M Coding: Impact on ROS

In early 2021, significant updates to Evaluation and Management (E/M) coding were introduced by the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS). These updates redefined what’s required in clinical documentation, moving away from the blanket expectation for a comprehensive ROS in every case. Now, clinicians are encouraged to focus on a “medically appropriate history and/or examination,” which means you can tailor the depth of the ROS according to the specifics of each encounter.

So, what does this mean for practice? The shift has sparked some debate. On one hand, it streamlines documentation, allowing you to concentrate on what is clinically relevant to the patient at hand. On the other, the careful, structured approach of an ROS can still uncover hidden conditions—a recent study showed that over 1 in 10 new problems were detected solely through a thorough ROS.

In essence, the ROS remains a valuable tool, but its use is now more flexible. There’s no longer a strict requirement for a full-system review at every visit. Instead, the emphasis is on clinical judgment: utilize the ROS thoughtfully to enhance patient care, identify crucial symptoms, and support accurate diagnoses when appropriate. Whether you choose to scale back or maintain a full review, your ultimate guide should be what best serves your patients and supports high-quality clinical decision-making.

1️⃣ Problem-Pertinent ROS

Focuses only on the system directly related to the chief complaint.

Example:

• Chief Complaint: “Cough”
• ROS: Patient reports dry cough for 3 days; denies chest pain, dyspnea, or fever.

2️⃣ Extended ROS

Covers the chief complaint system plus 2 to 9 additional systems to capture broader context.

Example:

• Chief Complaint: “Hypertension follow-up”
• ROS: Denies chest pain, palpitations (Cardiovascular), denies dizziness or headaches (Neurological), denies dyspnea (Respiratory).

3️⃣ Complete ROS

Includes 10 or more systems, often required for comprehensive annual exams, pre-op clearances, or complex assessments.

Example:

• Constitutional, Eyes, ENT, Cardiovascular, Respiratory, GI, GU, MSK, Neurological, Psychiatric.

⏳ How Long Does a Comprehensive ROS Usually Take?

For most clinicians, conducting a comprehensive Review of Systems takes about 5 to 10 minutes, though this timeframe can vary. Several factors influence the length: the complexity of the patient’s medical history, how many symptoms need follow-up questions, and the clinician’s familiarity with ROS workflows. In routine visits, the process is often smooth and efficient, but when patients present with multi-system complaints or ambiguous symptoms, expect to spend extra time ensuring nothing important is overlooked.

Busy days in clinic or hospital medicine may tempt shortcuts, but thoroughness pays off in diagnosis and documentation—especially when juggling multiple body systems and covering bases for regulatory compliance.

🌍 Review of Systems Templates Around the World

While the core goal of a Review of Systems template—to systematically screen for symptoms across organ systems—remains universal, the terminology can vary by region. In the United States and Canada, “review of systems template” is standard language, frequently found in hospital records and medical school syllabi, thanks to consistent use in electronic health systems and EMR tools.

In contrast, clinicians practicing in the United Kingdom, Australia, or New Zealand often refer to this format as a “systems enquiry” or “systems review.” Despite the different names, the structure and clinical intent are strikingly similar: guiding a clinician methodically through symptom checklists to ensure a thorough assessment, no matter the setting or healthcare system. The familiar frameworks—whether embedded in an Epic, Cerner, or local NHS template—are designed to catch hidden clues and provide clear, comprehensive documentation for optimal patient care.

📋 Why Use a ROS Template?

A well-designed ROS template is essential for:

✅ Ensuring Completeness: Reduces the risk of missing important symptoms.

✅ Reducing Mental Load: Provides structure and reminders for busy clinicians.

✅ Billing Compliance: Aligns with E/M documentation guidelines.

✅ Time Efficiency: Speeds up patient encounters and allows focus on key clinical issues.

✅ Improved Patient Safety: Identifies red flags early that may otherwise be overlooked.

By using DocScrib’s AI-driven ROS templates, clinicians can document these findings quickly, accurately, and in real-time.

🧩 Core Components of a Comprehensive ROS Template

A standard 14-system ROS includes the following systems and common prompts:

While the psychiatric section in a general ROS often lists depression, anxiety, and sleep disturbances, a more thorough psychiatric review delves deeper—covering key mental health domains such as mood, psychosis, cognition, behavior, appetite, and sleep. This expanded approach supports accurate mental health assessments and helps clinicians document patterns in a structured, DSM-V-aligned way.

Key Psychiatric Domains to Consider:

• Mood: Changes in mood, irritability, lability, anhedonia
• Sleep: Insomnia, hypersomnia, nightmares, sleep quality
• Psychosis: Hallucinations, delusions, paranoia
• Cognition: Memory loss, attention difficulties, disorganized thinking
• Appetite: Increased or decreased appetite, significant weight changes
• Behavior: Agitation, withdrawn behavior, impulsivity, aggression

📝 Example: Full ROS Documentation Sample

Here’s a sample ROS documentation as it might appear in a routine wellness visit:

Chief Complaint: Annual physical exam

Review of Systems:

• Constitutional: Denies fever, chills, fatigue, recent weight changes.
• Eyes: No blurred vision, eye pain, or discharge.
• ENT: Denies hearing loss, nasal congestion, sore throat.
• Cardiovascular: Denies chest pain, palpitations, leg swelling.
• Respiratory: Denies cough, wheezing, or shortness of breath.
• Gastrointestinal: No nausea, vomiting, diarrhea, constipation.
• Genitourinary: Denies dysuria, hematuria, or urinary frequency.
• Musculoskeletal: Denies joint pain, muscle aches, back pain.
• Neurological: No headaches, dizziness, tingling, or weakness.
• Psychiatric: Denies depression, anxiety, sleep issues. For comprehensive assessment, also screens negative for hallucinations, delusions, memory loss, changes in appetite, and behavioral disturbances.
• Endocrine: Denies heat or cold intolerance, polyuria, polydipsia.
• Hematologic/Lymphatic: Denies easy bruising, swollen glands.
• Allergic/Immunologic: Denies rashes, seasonal allergies, frequent infections.
• Integumentary (Skin/Breast): Denies skin changes, rashes, lumps, or itching.

By broadening the psychiatric review and maintaining clear, organized documentation, clinicians ensure a holistic view of the patient’s health—leaving no stone unturned.

🧠 How DocScrib Enhances ROS Documentation

DocScrib’s AI Medical Scribe revolutionizes ROS documentation by:

1. Listening and Capturing in Real-Time: As you conduct the ROS verbally, DocScrib transcribes and structures it automatically.
2. Auto-Formatting: Organizes patient responses system by system for immediate EHR-ready notes.
3. Customizable Templates: Allows you to adjust depth (problem-focused vs. full ROS) and personal preferences.
4. Time Savings: Reduces clinician documentation time by up to 70%.

🎯 Best Practices for Using ROS Templates

• Contextualize: Choose between focused, extended, or complete ROS based on visit type.
• Be Consistent: Use clear, concise language (e.g., “denies” vs. “reports”).
• Avoid Over-Documentation: Only document systems relevant to the visit to avoid clutter.
• Leverage Automation: Tools like DocScrib ensure accuracy without adding time burden.

✅ Key Takeaways

• The Review of Systems is crucial for comprehensive patient care and medical documentation.
• Using a structured ROS template improves efficiency, accuracy, and billing compliance.
• With DocScrib’s AI-powered tools, ROS can be documented faster, more consistently, and with less clinician stress.

👉 Download your free Review of Systems Template and discover how DocScrib can transform your patient documentation workflow today!